Sex and Intimacyhttps://blogs.psychcentral.com/sex
Sex, porn addiction and intimacy in relationships in a digital ageMon, 12 Feb 2018 23:08:24 +0000en-UShourly1PCSexAndIntimacyhttps://feedburner.google.comWorking with Partners of Sex Addicts: An Interview with Dr. Barbara Steffenshttps://blogs.psychcentral.com/sex/2018/02/working-with-partners-of-sex-addicts-an-interview-with-dr-barbara-steffens/
https://blogs.psychcentral.com/sex/2018/02/working-with-partners-of-sex-addicts-an-interview-with-dr-barbara-steffens/#respondMon, 12 Feb 2018 23:08:24 +0000https://blogs.psychcentral.com/sex/?p=1856Recently, I was able to speak to Dr. Barbara Steffens about her work and her thoughts on treating betrayed partners with understanding and empathy for their experience as trauma survivors, rather than automatically labeling and/or pathologizing them as codependent, enmeshed, enabling, and the like.]]>

My friend and colleague, Dr. Barbara Steffens, has specialized in the treatment and coaching of sex addicts and the betrayed partners of sex addicts since 1999. During that time, she has conducted groundbreaking research on the trauma that betrayed partners experience, and she has written an excellent (and highly recommended) book on the topic, Your Sexually Addicted Spouse: How Partners Can Cope and Heal. Dr. Steffens is also a founding member and current President of APSATS: The Association of Partners and Sex Addicts Trauma Specialists. Recently, I was able to speak to her about her work and her thoughts on treating betrayed partners with understanding and empathy for their experience as trauma survivors, rather than automatically labeling and/or pathologizing them as codependent, enmeshed, enabling, and the like. What follows is an excerpt from our conversation that both clinicians and lay readers may find useful.

Can you talk briefly about your study, where you looked at betrayed partners of sex addicts from the trauma perspective?

The research looked at trauma symptoms in betrayed partners after they learned about their spouse’s sexual addiction and betrayal. We expected to find some evidence of trauma symptoms when we undertook the study, but the level of trauma was a complete surprise. To our amazement, we found that 69.9% of the people who participated met the DSM criteria for posttraumatic stress disorder (PTSD). Some readers of the study might argue that the “life-threatening trauma” criterion of PTSD was not met, but the participants and the betrayed partners that I work with on a regular basis would absolutely disagree. When you love someone, learning about sexual betrayal really is life threatening, not just in the literal sense, but in the sense that it threatens every part of your life.

Even though I was surprised by the high percentage of participants with PTSD, it validated what I was seeing clinically. And once the study was published, other clinicians contacted me and let me know that it validated what they were experiencing, as well. However, the strongest response to the research came from betrayed partners after we published the book. They read the book and found that the trauma model really resonated with them.

Do you find that betrayed partners actually have PTSD, or that they just display the symptoms for a certain time frame, like a few weeks or a few months?

With the research, we asked them to complete the assessment based on their initial symptoms and reactions, and their current symptoms and reactions. And we made sure it had been at least six months since they’d learned about the infidelity and addiction because we wanted to compare over time. What we found was that most of the participants were still experiencing posttraumatic symptoms after six months. I would say that not all betrayed partners meet the full criteria for PTSD, but the majority do have at least some level of posttraumatic stress symptoms for a period.

What aspects of sexual addiction are most traumatic for the partner? Is it the sex itself, or is it the secrets and lies and loss of trust?

In the study, we didn’t specifically separate that out, but I can tell you anecdotally that it’s the deception. One thing we did look at in this regard was factors that increased the intensity of the trauma. We came up with two, and one was the length of time in the relationship before there was discovery. The longer the secret life was going on, the more intense the traumatic symptoms were. And that makes sense. Betrayed partners have their perception of what their life is, and then they find out that this person who’s always supposed to have their back, so to speak, has been hiding something from them, in some cases for their entire relationship. It’s a little like an earthquake. It just rattles everything you think you know about your life.

Dr. Barbara Steffens

Can you briefly describe the process of safe disclosure about sexual addiction? How do cheaters/addicts tend to screw it up, and how do betrayed partners tend to screw it up?

We need more research to support what I’m about to say, but we tend to find that planned, therapeutically supported disclosure is the best method. The worst way is when betrayed partners are blindsided by the information. That’s just horrific. We also know that prolonged disclosure, where it’s a little bit at a time, where it trickles out, is awful for the betrayed partner because it’s an earthquake, and an earthquake, and then another earthquake. When their world is still shaking, they can’t start to heal.

We also find that disclosure is best done as soon as possible, as long as it’s well supported. There needs to be a therapist or coach there to fully support the betrayed partner, along with a person to support the addict, and everyone should be supportive of the relationship. Unfortunately, that doesn’t always happen. In fact, it rarely happens. But that is the best-case scenario.

The support needs to start well before the actual disclosure. The support system prepares the addict and partner for that event, while also helping them manage their emotions throughout and after the process. As part of the preparation, I think the best guidance for the addict is to give the information that the betrayed partner wants—no more and no less. To this end, I strongly advocate preparing the betrayed partner to ask for the desired information. But you have to be careful here. One problem I hear about relatively often is partners who demand a lot of very specific details—names, places, specific actions—that turn out not to be as helpful to them as they were hoping. They don’t seem to understand that once they hear that information, there is no way they can get it out of their brain. Another issue is that they sometimes short-circuit the preparation phase and fail to ask for everything they want and need. That comes out of anxiety, wanting to get it over with without more pain.

Another issue I see with disclosure is that couples wait too long. Sometimes when a disclosure is taking too long to get going, it’s not because the partner’s not ready, or the addict’s not ready, it’s because the addict’s therapist is not doing the prep work for disclosure or even bringing up disclosure as an option. As a partner specialist, a lot of times I’m the first one to give the partner and the addict information about therapeutic disclosure and to say it would be good to start working on that as soon as we can.

*

For more information about effective disclosure that heals rather than harms, please read Dr. Steffen’s book, Your Sexually Addicted Spouse: How Partners Can Cope and Heal or visit the APSATS website. Betrayed partners, if interested, can complete an anonymous survey about disclosure experiences on the APSATS site. This survey is being used to gather information about betrayal and disclosure, and to develop more effective methods of disclosure and healing.

At the age of 20, Steven came out as gay to his highly religious parents. As members of a very conservative sect, they struggled to accept his “choice” as “normal,” and they decided to seek advice from their pastor. Unfortunately, their pastor, a trained and licensed pastoral counselor, suggested “sex addiction treatment” with another therapist in their religious community. In this treatment, Steven was given a variety of highly homophobic tasks to complete—participating in sports, which he hated, mimicking the way that “normal” men move and talk, which felt unnatural to him, becoming more assertive with women, which caused distress to not only him but his female friends, etc. Unsurprisingly, this therapist’s attempts to change Steven’s “sexually addictive behavior” failed miserably. Even worse, this failure disheartened Steven and created within him a significant amount of shame and self-loathing.

Unfortunately, without an official criteria-based diagnosis for sexual addiction, it’s easy misuse the label “sex addiction,” preying on personal and societal fears and biases. Because of this, plenty of confused individuals, plus the media and even a few misguided clinicians will, at times, attempt to address any form of sexual desire or behavior that does not mesh with their religious, personal, or societal standards as sexual addiction. These individuals often say or hear things like:

“A woman who works for Ed accused him of harassment. He must be a sex addict.”

“Marie sleeps around. Obviously, she’s a sex addict.”

“In our church, viewing porn once is a mistake, viewing it more than once is a pathological sin.”

“Jack loves his wife and he’s got two kids, so his interest in men must be sex addiction.”

“Roberta is really nice, except she likes to dress up like a dominatrix and spank her boyfriends. She should probably start going to 12-step meetings for sex addicts.”

Happily, the World Health Organization’s forthcoming update to its International Classification of Diseases (the ICD-11), scheduled for publication later this year, will list compulsive sexual behavior disorder as an official diagnosis, delineating the parameters by which we do (and don’t) define sexual addiction (also referred to as hypersexuality, hypersexual disorder, sexual compulsivity, and compulsive sexual behavior disorder). It seems likely the APA will follow suit with its next revision of the DSM, and that should further clarify the situation.

In the interim, I will use this space to debunk some of the more painful mythology around compulsive sexual behavior.

Sex addiction is NOT fun. When you say the words sex addiction, the kneejerk response is usually something like, “Hey, sounds fun. Sign me up.” In reality, sex addiction is the opposite of fun. It is a compulsion that leads to shame, depression, anxiety, and a wide variety of negative consequences—just like every other form of addiction. Sex addiction is not about having a good time any more than alcoholism is about having a good time.

Sex addiction is NOT an excuse for problematic behavior. Some people use the sex addiction label as a catch-all excuse for infidelity, sexual misconduct, and other consequence-causing sexual behavior. They get caught up in inappropriate, maybe even illegal sexual behavior—harassment, voyeurism, illegal porn, etc.—and blame their actions on an addiction, usually hoping to avoid or at least minimize the judgment and/or punishment they receive. Sometimes these individuals really are sex addicts, but just as often they are not. Either way, a diagnosis of sexual addiction never justifies bad behavior. Under no circumstances are sex addicts absolved of responsibility for the problems their choices have caused.

Sex addiction is NOT related to sexual orientation. Neither homosexual nor bisexual arousal patterns are factors in the diagnosis of sexual addiction, even if those arousal patterns are ego-dystonic (unwanted). Being gay, lesbian, or bisexual does not make you a sex addict any more than being straight makes you a sex addict. Sometimes self-loathing, closeted homosexuals or bisexuals will seek out sex addiction treatment, hoping to change their sexual orientation. Occasionally they do this at the behest of a misguided clinician, clergy member, or family members, as occurred with Steven in the example above. However, changing one’s arousal template is not possible. If you’re attracted to men, that’s the way it is; if you’re attracted to women, same story; and if you like both genders, you’d better get used to it, because that’s not going change.

Sex addiction is NOT related to fetishes or paraphilias. Fetishes and paraphilias are recurrent, intense, sexually arousing fantasies, urges, and behaviors involving nonhuman objects, specific body parts, the abasement of oneself or one’s sexual partner, nonconsensual sex (in appearance or actuality), and the like. We’re talking about BDSM, foot worship, chubby chasing, etc. Fetishes and paraphilias may cause a person to keep sexual secrets, to feel shame and distress, and even to feel out of control at times, but they are not indicators of sexual addiction. Sexual addiction is not in any way defined by who or what it is that turns a person on.

Sex addiction treatment is NOT sex negative. In some quarters, there is a fear that sex addiction therapists are trying to be the new sex police, imposing moral, cultural, or religious values on sexuality. This fear is not ungrounded; there are at least a few misinformed, moralistic, and/or highly religious therapists who willingly misapply the sex addiction label as a way of marginalizing and pathologizing sexual behaviors that don’t mesh with their belief systems. Homosexuality, bisexuality, transgenderism, recreational porn use, casual sex, polyamory, and kink and fetishes—all of which fall well within the spectrum of healthy adult sexuality—have at times been pathologized in this way. (The forthcoming ICD-11 diagnosis should eliminate the bulk of these misdiagnoses.)

Sex addiction is NOT just a guy (or a gay) thing. The common perception is that only a man can be a sex addict. While it is true that about 70% of the people we see in sex addiction treatment are men, the remainder are women, most often with deep sexual abuse histories. That said, men are usually easier to diagnose because they are generally more open about the purely sexual nature of what they are doing. Women tend to talk about the issue in terms of relationships, even when they’re having just as much sex, and the same types of sex, as their male counterparts.

Sexual addiction should NOT be conflated with substance use disorder, bipolar disorder, or any other psychiatric diagnosis. To accurately diagnose sexual addiction, we must first rule out any number of major mental health disorders that can include hypersexuality as a symptom. Some of these include substance use disorder, the manic phase of bipolar disorder, obsessive-compulsive disorder, and attention-deficit/hyperactivity disorder. So, not everyone who is compulsively sexual has a problem driven by sexual addiction. Other disorders can also be the cause of hypersexual behavior. That said, it is possible to have any of these other conditions and to also be sexually addicted (or alcoholic, drug addicted, etc.).

As any therapist knows, the beginning of the year is when a lot of new clients show up, and when a lot of old clients decide to get serious about the work they’ve been doing. They seem to view the new year as a great time for a fresh start. This is especially true with addicts. Unfortunately, an addicted client’s enthusiasm for recovery can wane as quickly as our own resolutions to go to the gym every day, eat better, etc. The good news is there are things we can do, as therapists, that can help our clients make andsustain desired changes.

Set (or Reset) Goals

When I suggest setting/resetting goals as part of addiction-focused therapy, I’m talking about more than just the surface actions of goal setting, such as “I want to stop drinking.” What I’m talking about here is the deeper dive, looking at why a client’s goals matter. Why does the client want to quit drinking? What parts of the client’s life will improve as a direct result of meeting this goal? And which of those facets of life are most important as motivation for the client?

If it seems appropriate, you can assign this as a homework exercise, asking the client to list one to three very specific recovery-related goals for the upcoming year, with five to ten reasons why each of those goals is important. This work can then be discussed in therapy to provide clarity not only for the addict, but for you as a helping professional.

Create a Workable Action Plan

Addicted clients nearly always benefit from a written plan of action for achieving their goals. And I can’t stress the word “written” strongly enough. Make them write their action plan down. There’s something powerful about writing something down before reading it and discussing it in therapy (and maybe elsewhere). The act of writing a plan down gives it heft and credence that verbalization alone doesn’t create.

With my addicted clients, I usually suggest a three-tiered “traffic signals” plan, with red lights, yellow lights, and green lights. And yes, this is exactly what it sounds like. If a client’s goal is to stop drinking, red light behaviors would be things like drinking alcohol, buying alcohol, and hanging out in a bar. Yellow light behaviors could be things like going to a party where alcohol is freely available, feeling anxiety and not talking about it to a friend or in therapy, and skipping AA meetings or therapy sessions. Green light behaviors are positive actions the client can take instead of drinking. These can be immediate and concrete, like spending more time with the kids, painting the house, and taking up a hobby, or longer-term and less-defined, like going back to school, finding a more fulfilling job, and building a better marriage.

Once the client has created an action plan, the plan should be discussed in therapy, and perhaps with friends, family, and the client’s 12-step sponsor, with the client seeking feedback and amending his or her plan based on that feedback.

Identify Warning Signs for Slippage

This is an extension of the “yellow lights” portion of the action plan. I’m giving it separate attention here because these are certain issues that addicts don’t normally think about when creating an action plan. If you think it will be helpful, you can present your addicted client with the following list of slippery slope items to watch out for, discussing this list in therapy and identifying ways to combat these issues.

Overconfidence: “This is going great. Maybe I’ve got this problem under control and I can relax a bit.”

Denial: “I’ve had this under control for an entire week now, so obviously it’s not as big of a problem as I thought.”

Minimization: “It’s not a big deal if I ‘give in’ just this once, for a few minutes.”

Isolation: “I can handle this on my own. I don’t need therapy or any other support. I don’t need others to help me with this.”

Blaming: “This really isn’t my fault. My parents neglected and abused me, and I behave this way because of them. They should be the ones in therapy, not me.”

Devaluing Feedback: “My therapist and the people in my 12-step group don’t really understand what I’m going through, so I don’t need to take their advice.”

Feeling Like a Victim: “If the world didn’t suck so much, I wouldn’t want to….”

Rationalizing: “It’s OK for me to backslide a little when traveling for work or on vacation. My action plan doesn’t count when I’m in a different state.”

Feeling Entitled: “I’ve worked really hard on my recovery, and I’ve been putting in extra hours at work, too, so I deserve a little treat.”

This is an extension of the “green lights” portion of the action plan. Again, these possibilities can be discussed (and even practiced) in therapy as a way of familiarizing addicted clients with their healthy options.

Gratitude: One of the best ways to combat anxiety, depression, stress, and other triggers toward addiction is to practice gratitude. In therapy, I often ask my addicted clients to, on a daily basis, list ten things they are grateful for. Some clients struggle with this initially. If so, I ask them to stick with it, knowing the task gets easier with practice. I also ask them to pay attention to how their thoughts and feelings change both in the moment and over time. Usually, they come to see that’s it’s impossible to be grateful and unhappy at the same time.

HALT: HALT is an acronym for Hungry, Angry (or Anxious), Lonely, and Tired. Addicts can learn to HALT and check in with themselves to see what they’re feeling and experiencing at any given time. If they’re out of sorts, they can ask themselves, “When is the last time I had something to eat, did I get enough sleep last night, am I ticked off or worried about something, am I feeling lonely or isolated?” Usually, a sandwich, a nap, or a quick phone call to a friend or loved one will change the addict’s mood and decrease the odds of relapse.

Bookending: Life is filled with temptations, and often these potential pitfalls can be seen well in advance. For instance, a client who wants to stop drinking may need to attend a work-related event with an open bar. If so, the client can call a supportive friend before the event to check in and to discuss a plan for staying sober (including leaving the event if necessary). After the event, the client can call that same friend to discuss what happened, the feelings that came up, and what the client might want to do differently in the future.

For the most part, keeping addicted clients on track and focused on their goals for change is the same at the beginning of the year as any other time of year. However, because addicts are often more motivated now as opposed to later, it may be useful to push them a bit harder than usual by asking them to examine their goals in greater detail, to create and commit to an action plan, and to look at and plan for potentially slippery situations. With this work, addicted clients have a much better chance of ultimately reaching their goals, though they are still likely to do so imperfectly.

There is a lot of confusion and misinformation about sexual addiction, much of which centers around the way in which “sexual sobriety” is (and is not) defined. For starters, a lot of people, including some underinformed therapists, think that clinicians who treat sex addiction dictate to their clients what is and is not healthy, which would leave the definition of sexual sobriety open to the clinician’s personal, moral, and/or religious views about what sex should look like, with whom you should have it, and how often you should have it. This could include possible interpretations like, “If you’re not legally married to an opposite sex spouse, you should not be having sex with anyone, including yourself.”

Yikes!

Happily, after nearly three decades treating sex addicts and their families, and training other therapists to do the same, I can assure you that this is not the way in which sexual sobriety is defined. Certified sex addiction therapists are not the sex police, nor do we wish to be. In fact, as a rule we are incredibly sex positive, encouraging any and all forms of sexual expression, as long as they’re not obsessive, compulsive, and out of control in ways that harm self or others. Same-sex behaviors, fetishes, kinks, and all other forms of legal and consensual sexual activity are perfectly acceptable as far as we are concerned—even for recovering sex addicts. Anyone who says differently is either misinformed or lying.

A similar concern, generally expressed by sex addicts themselves, is that sexual sobriety requires long-term abstinence (as we typically see with recovery from substance and gambling addictions), or at least long-term abstinence from the types of behaviors that turn them on the most. In fact, one of the first questions I am likely to hear when starting work with a newly recovering sex addict is, “Will I ever have a healthy and enjoyable sex life, or do I have to give up hot sex forever?” Often, that is followed by a statement like, “If I have to give up sex permanently, or my favorite flavor of sex permanently, you can forget about me staying in recovery.”

I do not in any way fault my clients for this attitude. Instead, I tell them that unlike certain other forms of addiction sobriety, sexual sobriety is not defined by long-term deprivation. With sex addiction, we define sobriety as we do with eating disorders—another area where long-term abstinence is neither desired nor feasible. So, instead of permanently abstaining from all sexual activity or even certain types of sexual activity, recovering sex addicts define sexual sobriety in ways that help them be sexual in non-compulsive, non-problematic, life-affirming ways.

Individually Defining Sexual Sobriety

On the heels of the conversation described above, newly recovering sex addicts tend to ask, “If sexual sobriety doesn’t require lasting sexual abstinence, what does it require?” The good news (and maybe also the bad news, for those who like rigid rules) is there’s no cut-and-dried answer to this question. Each sex addict enters the process of recovery with a unique life history, a unique set of compulsive sexual behaviors that are causing problems, and a unique set of goals for the future. Based on this information, each sex addict is encouraged to craft a personalized definition of sobriety. This means each addict’s definition of sexual sobriety will be his or hers alone. Moreover, sexual behaviors that are highly problematic for one recovering sex addict might be perfectly fine for another. For example, sexual sobriety for 28-year-old single gay man could (and probably will) only loosely resemble sexual sobriety for a 48-year-old married father of three. The goal of sexual sobriety is not conformity; the goal is a non-compulsive, non-shaming, consequence-free sexual life.

Sexual Boundary Plans

Recovering sex addicts, after defining what sexual sobriety means to them, typically put this into effect through use of a sexual boundary plan. These plans define and set limits on which sexual behaviors are and are not acceptable for that addict.

Typically, the process of creating a sexual boundary plan begins with a statement of goals, where recovering sex addicts list the primary reasons they want to change their sexual behavior. A few commonly stated goals are as follows:

I don’t want to cheat on or keep secrets from my significant other.

I want to be present in the real world instead of living my life online.

I don’t want to “lose myself” in pornography ever again.

I don’t want to put my health and my self-esteem at risk through sexual behaviors.

I want to feel like a whole, integrated, healthy person, like I’m living my life with integrity.

Once a sex addict’s goals for recovery are clearly stated, he or she can move forward with the creation of a personalized plan for sobriety, using his or her pre-established goals as an overall guide. Sometimes sexual sobriety plans are simple, straightforward statements like, “I will not engage in sexual infidelity no matter what,” or, “I will not view pornography of any kind.” More often, sex addicts implement a more detailed, three-tiered set of guidelines constructed as follows:

The Inner Boundary: This boundary lists the specific sexual actions that lead to negative life consequences and incomprehensible demoralization for the addict. If the addict engages in these behaviors, he or she has “slipped” and will need to reset his or her sobriety clock (while also doing a thorough examination of what lead to the slip). A few common inner boundary behaviors are as follows:

Paying for sex.

Calling an ex for sex.

Going online for porn.

Masturbating to porn.

Engaging in webcam sex.

Getting sensual massages.

Hiring prostitutes.

Hooking up for casual and/or anonymous sex.

Having affairs.

Exhibiting oneself (online and/or real world).

The Middle Boundary: This boundary lists warning signs and slippery situations that might lead a sex addict back to inner boundary activities. Here, the addict lists the people, places, thoughts/fantasies, events, and experiences that might trigger his or her desire to engage in problematic (non-sober) sexual behaviors. In addition to obvious potential triggers (logging onto the Internet, driving through a neighborhood where prostitutes hang out, downloading a hookup app, etc.), this list includes things that might indirectly trigger a desire to act out (working long hours, arguing with a spouse or boss, keeping secrets, worrying about finances, etc.) A few common middle boundary items are as follows:

Skipping therapy and/or a support group meeting.

Lying (about anything), especially to a loved one.

Poor self-care—lack of sleep, eating poorly, forgoing exercise, etc.

Working more hours than usual.

Spending time with family of origin—holidays, reunions, etc.

Fighting and/or arguing with anyone, especially with loved ones.

Unstructured time alone.

Traveling alone (for any reason).

Feeling lonely.

Feeling bored.

The Outer Boundary: This boundary lists healthy behaviors and activities that can and hopefully will lead a sex addict toward his or her life goals—including but not even remotely limited to having a healthy, non-destructive sex life. These healthy pleasures are what addicts turn to as a replacement for sexual acting out. Outer boundary activities may be immediate and concrete, such as “working on my house,” or long-term and less tangible, such as “redefining my career goals.” In all cases, the list should reflect a healthy combination of work, recovery, and play. A few common outer boundary behaviors are as follows:

Spend more time with family, especially the kids.

Reconnect with old friends.

Rekindle an old hobby or develop a new one.

Get in shape.

Get regular sleep.

Work no more than eight hours per day.

Rejoin and become active in church.

Go back to school.

Work on the house and yard.

Do volunteer work.

Once again, and I can’t stress this enough, every sex addict is different. Each addict has a unique life history, singular goals, and specific problematic sexual behaviors. Therefore, every definition of sexual sobriety and every sexual boundary plan is different. Behaviors that are deeply troubling for one sex addict could be perfectly acceptable for another, and vice versa. As such, there is no set formula for defining and living sexual sobriety. Conformity is not the goal. Living a healthy and fulfilling life is what matters.

]]>https://blogs.psychcentral.com/sex/2017/12/with-sex-addiction-sobriety-looks-different-for-every-addict/feed/0Infidelity and “Gaslighting:” When Cheaters Flip the Scripthttps://blogs.psychcentral.com/sex/2017/05/infidelity-and-gaslighting-when-cheaters-flip-the-script/
https://blogs.psychcentral.com/sex/2017/05/infidelity-and-gaslighting-when-cheaters-flip-the-script/#commentsWed, 17 May 2017 18:59:59 +0000https://blogs.psychcentral.com/sex/?p=1831Gaslighting is a form of psychological abuse where one partner persistently denies the reality of the other partner (via consistent lying, bullying, and obfuscating the facts), causing that person, over […]]]>

Gaslighting is a form of psychological abuse where one partner persistently denies the reality of the other partner (via consistent lying, bullying, and obfuscating the facts), causing that person, over time, to doubt her (or his) perception of truth, facts, and reality. Some people may be familiar with this term thanks to Gaslight, the 1944 Oscar winning film starring Ingrid Bergman and Charles Boyer. In the story, a husband (Boyer) tries to convince his new wife (Bergman) that she’s imagining things, in particular the occasional dimming of their home’s gas lights. (This is part of his plan to rob her of some very valuable jewelry.) Over time, the wife, who trusts that her husband loves her and would never hurt her, starts to believe his lies and to question her perception of reality.

In the 21st century, the rather antiquated and convoluted plot of Gaslight seems a bit silly. Still, the psychological concept of gaslighting – insisting that another person’s perception of reality is wrong and/or false to the point where that person begins to question that perception – is well accepted, particularly in connection with sexual and romantic infidelity.

Gaslighting is similar in many respects to one of my favorite (if I’m allowed to have one) psychiatric syndromes, folie à deux, which literally translates to “madness in two.” Basically, folie à deux is a delusional disorder in which delusional beliefs and/or hallucinations are transmitted from one individual to another due to their close proximity, emotional connection, and shared reality. In short, crazy for two. If you are in a close relationship with an actively psychotic person – for instance, a person who hears voices and is afraid of being watched – you might also start to hear voices and fear being watched. Such is the power of emotional connections and our desire to hold onto them. We can actually distort our own sense of reality.

The primary difference between folie à deux and gaslighting is that with gaslighting, the person denying reality is perfectly aware of the fact that he or she is lying, usually as a way to manipulate the other person. But the effects are no less profound. Consider the following story, told to me by Alexandra, a female client who came to see me after learning about her long-term boyfriend’s infidelity.

Jack and I met at a party. I was 25, he was 30. We’ve been dating for six years now, living together for five, and he keeps promising me we’ll get married and start a family, but that never quite happens. The last three or four years, even though we’re sharing an apartment, I almost never see him. He works in finance, and I know the hours are long, but sometimes I feel lonely and I try to call him but he doesn’t answer his phone, even when he’s gone all night. He doesn’t even respond to my texts, just to let me know he’s not dead. If I dare to ask him about using cocaine with his friends or sleeping with another woman, he calls me insecure and paranoid and all sorts of other things. Then he reminds me that his job is really demanding and I should cut him some slack. He tells me that if I truly want to get married and have kids with him then I need to stop acting crazy. Well, a couple of days ago I saw him at a café with another woman, kissing her across the table. That night, after he was asleep, I went through his phone and found out he’s been having affairs with at least three other women. In the morning, when I confronted him, he told me that he wasn’t at the café where I saw him, and that I was misinterpreting all the texts I found. And I actually started to believe him! Now, instead of being mad, I feel crazy. I can’t eat, I can’t sleep, I can’t think straight, and I have absolutely no idea what is real and what isn’t.

Sadly, Alexandra’s story is not unusual. In cases of romantic and sexual infidelity, almost every betrayed partner experiences gaslighting to some degree. They sense that something is wrong in the relationship, they confront their significant other, and then the cheater “flips the script,” adamantly denying infidelity and asserting that the betrayed partner’s discomfort is based not in fact, but in paranoia and unfounded fear. Basically, cheaters insist that they’re not keeping any secrets, that the lies they’ve been telling are actually true, and that their partner is either delusional or making things up for some absurd reason.

The (typically unconscious) goal of gaslighting is to get away with bad behavior. Cheaters gaslight because they don’t want their spouse to know what they are doing, or to try and stop it. So they lie and keep secrets, and if/when their partner catches on and confronts them, they deny, make excuses, tell more lies, and do whatever else they can do to convince their partner that she (or he) is the issue, that her (or his) emotional and psychological reactions are the cause of rather than the result of problems in the relationship. Basically, the cheater wants the betrayed partner question her (or his) perception of reality and to accept blame for any problems.

At this point, you might be thinking that you could never be a victim of gaslighting because you’re too smart and too emotionally stable. If so, you need to think again. Alexandra, in the example above, has a PhD in Economics from a world-class university, currently teaches at that same school, has wonderfully supportive parents and friends, and has zero history of emotional and psychological instability (beyond her partner’s cheating). Yet her boyfriend manipulated her perception of reality for the better part of six years, eventually causing her to question both her instincts and her sanity, before she finally caught him red-handed. And then, instead of being angry with him, she was angry with herself and unsure of the truth.

The ability to fall for a cheating partner’s gaslighting is NOT a sign of low self-esteem or a form of weakness. In fact, it is based in a human strength – the perfectly natural tendency of loving people to trust the people that we care about, and upon whom we are healthfully emotionally dependent. In short, we want (and even need) to believe the things that our loved ones tell us.

In large part, betrayed partners’ willingness to believe even the most outrageous lies (and to internalize blame for things that are clearly not their fault) stems from the fact that gaslighting starts slowly and builds gradually over time. It’s like placing a frog in a pot of warm water that is then set to boil. Because the temperature increases only slowly and incrementally, the innocent frog never even realizes it’s being cooked. Put another way, a cheater’s lies are usually plausible in the beginning. “I’m sorry I got home at midnight. I’m working on a very exciting project and I lost track of time.” An excuse like that sounds perfectly reasonable to a woman (or man) who both loves and trusts her (or his) partner, so it’s easily accepted. Then, as the cheating increases, so do the lies. Over time, as betrayed partners become habituated to increasing levels of deceit, even utterly ridiculous fabrications start to seem realistic. So instead of questioning the cheater, a betrayed and psychologically abused partner will simply question herself (or himself).

Sadly, gaslighting can result in what is known as a “stress pileup,” leading to anxiety disorders, depression, shame, toxic self-image, addictive behaviors, and more. As such, gaslighting behaviors are often more distressing over time than whatever it is that the betrayer is attempting to keep under wraps. With Alexandria, for instance, the most painful part of her boyfriend’s behavior wasn’t that he was having sex with other women, it’s that he was never trustworthy and made her feel crazy for doubting his endless excuses.

]]>https://blogs.psychcentral.com/sex/2017/05/infidelity-and-gaslighting-when-cheaters-flip-the-script/feed/5Infidelity: Why Do Men Cheat?https://blogs.psychcentral.com/sex/2017/02/infidelity-why-do-men-cheat/
https://blogs.psychcentral.com/sex/2017/02/infidelity-why-do-men-cheat/#commentsThu, 23 Feb 2017 20:47:14 +0000https://blogs.psychcentral.com/sex/?p=1823In my recently published book, Out of the Doghouse: A Step-by-Step Relationship-Saving Guide for Men Caught Cheating, I define infidelity as “the breaking of trust that occurs when you keep intimate, meaningful secrets from your primary romantic partner,” noting that this definition encompasses behaviors other than actual sexual intercourse, that purely online behaviors can still be cheating, and that behaviors that might qualify as cheating in one couple might be perfectly OK for another couple, depending on the relationship boundaries that each couple has agreed upon. For instance, one couple might decide that occasionally looking at porn does not violate their relationship fidelity, while another couple could feel differently.

In addition to defining infidelity, Out of the Doghouse presents a roadmap for healing damaged relationships. Essentially, the book was written to help men move beyond their usual feeble efforts to smooth things over by saying “I’m sorry” and trying buy forgiveness with flowers and jewelry—actions that can temporarily calm the stormy seas but do nothing to re-establish relationship trust, which is what a distraught partner needs if the relationship is going to survive and eventually thrive.

With all of the great information presented in Doghouse, I am perpetually amazed that the information betrayed spouses tend to be most interested in, at least initially, is the section on why their man cheated. When I talk to cheating men, of course, they initial give all kinds of excuses for their behavior, tending to rationalize, minimize, justify, and blame everyone but themselves for the damage done. They tell themselves (and anyone else who questions their actions) things like:

This is totally normal. All guys want to cheat, and when the opportunity arises, they act on it.

If my wife hadn’t gained so much weight since the kids came, I wouldn’t have even thought about sleeping around.

Monogamy means no romantic connections, like no kissing, no cuddling, and no getting attached. Well, a lap dance in a strip club is hardly a romantic connection. It’s just what guys do for fun.

If my job wasn’t so stressful, I wouldn’t need the release that porn gives me.

I’m only sexting. I don’t meet up with any of these women in person, so it’s not cheating.

My dad looked at porn and it wasn’t a big deal. Well, I have webcam chats and interactive sex. What’s the difference?

In addition to the statements listed above (and hundreds of similar rationalizations), cheating men also tell themselves, “What she doesn’t know can’t hurt her.” This is the biggest lie of all, as betrayed spouses invariably say they sensed an emotional and sometimes even a physical distancing before they learned about the cheating. Sadly, betrayed spouses often blame themselves for this distancing, wondering what they’ve done to create it and to provoke their mate’s defensiveness and anger if/when they questioned him about the lack of intimacy they felt.

Given these facts, it’s hardly surprising that cheated on spouses tend are so deeply invested in learning the real reasons their man cheated, as opposed to what they’ve heard with his endless and endlessly lame excuses. Generally, the true impetus for a man engaging in infidelity centers on one or more of the following:

Insecurity: He may feel as if he is not handsome enough, rich enough, smart enough, powerful enough, young enough, etc. To alleviate his insecurity, he seeks validation from women other than his mate, using their spark of interest to feel wanted, desired, and worthy. In short, he uses sextracurricular activity to bolster his flagging ego and feel better about himself.

Entitlement: He may feel like he deserves something special that is just for him—a sensual massage, a prostitute, a few hours with porn, a sexual affair, etc. He convinces himself that he is put-upon in some way by the people in his life, and he uses this to justify his cheating.

Selfishness: His primary consideration may be for himself and himself alone. He can therefore lie and keep secrets without remorse or regret as long as it gets him what he wants. It’s possible that he never intended to be monogamous. Rather than seeing his vow of fidelity as a sacrifice made to and for his relationship, he views it as something to be avoided and worked around.

Psychological Trauma: He may be reenacting and/or latently responding to unresolved childhood traumas—neglect, emotional abuse, physical abuse, sexual abuse, etc. Basically, from a psychological standpoint, his childhood wounds have created attachment issues that leave him unable and/or unwilling to fully connect with and commit to one person.

Co-Occurring Issues: He may have an ongoing problem with alcohol and/or drugs that affects his decision-making, resulting in regrettable sexual decisions. Or maybe he has a problem with sexual addiction, meaning he compulsively engages in sexual fantasies and behaviors as a way to numb out and avoid life. (This “desire for escape” is also why alcoholics drink, drug addicts get high, compulsive gamblers place bets, etc.)

Unrealistic Expectations: He may feel that his partner should fulfill his every whim and desire, sexual and otherwise, 24/7, regardless of how she is feeling at any particular moment. He fails to understand that she has a life of her own, with thoughts and feelings and needs that don’t always involve him. When his expectations are not met, he seeks validation and fulfillment elsewhere.

Misunderstanding Limerence: He may not understand the difference between romantic intensity and long-term love. So he mistakes the neurochemical rush of early romance, technically referred to as limerence, for love, and he acts accordingly.

Lack of Male Social Support: Over time, he may have undervalued his need for supportive friendships with other men, expecting his social and emotional needs to be met entirely by his significant other. And when she inevitably fails in that duty, he seeks validation and fulfillment elsewhere.

Biology: He may think it is a man’s evolutionary right/imperative to spread his seed as widely as possible. So he acts on this belief even though it conflicts with his commitment to monogamy and breaches relationship trust.

Unfettered Impulse: He may have not thought much about cheating until Busty Brenda hit on him at the office party, letting him know she was up for it whenever, wherever. But then, without even thinking about what his behavior might do to his relationship, he went for it.

It’s Over, Version 1: He may want to end his current relationship, but instead of just telling his significant other that he’s unhappy and wants to break things off, he cheats and forces her to do the dirty work.

It’s Over, Version 2: He may want to end his current relationship, but not until he’s lined up a replacement relationship. So he sets the stage for his next relationship while still in the first one, without ever letting his current partner know she is being strung along in this way.

For most men, there is no single factor driving the decision to cheat. And sometimes a man’s reasons for cheating evolve over time as his life circumstances change. Regardless of a man’s reasons for cheating, he needs to understand that he didn’t have to do it. There are always other options—couple’s therapy, taking up golf, being open and honest and working to improve the relationship, even separation and/or divorce. All of these are choices that don’t involve degrading and potentially ruining one’s integrity and sense of self.

Interestingly, betrayed spouses typically realize over time that they don’t actually care why their man cheated, even if that information seemed incredibly important in the immediate aftermath of discovery. Eventually, what they tend to focus on the most is the loss of relationship trust wrought by all of the cheater’s lying and secret keeping. Similarly, men who’ve cheated often realize that the reasons they did it matter far less than what they are going to do in the future—what kind of husband, father, lover, friend, and partner they will be moving forward. Can they be honest and maintain fidelity, or will it be more of the same?

I will discuss the process of healing from infidelity and restoring relationship trust in future postings to this site.

]]>https://blogs.psychcentral.com/sex/2017/02/infidelity-why-do-men-cheat/feed/6Sex and Porn Addictions: Misconceptions and Biashttps://blogs.psychcentral.com/sex/2016/12/sex-and-porn-addictions-misconceptions-and-bias/
https://blogs.psychcentral.com/sex/2016/12/sex-and-porn-addictions-misconceptions-and-bias/#commentsWed, 14 Dec 2016 01:58:48 +0000http://blogs.psychcentral.com/sex/?p=1815I’ve spent the past 25 years providing clinical treatment to sex addicts and their families, while also training therapists and documenting the clinical evolution of this increasingly common issue. Throughout […]]]>

I’ve spent the past 25 years providing clinical treatment to sex addicts and their families, while also training therapists and documenting the clinical evolution of this increasingly common issue. Throughout this time I have been constantly surprised by a small but vocal group of misguided and/or under-informed professionals who doggedly insist that sexual addiction is not a real disorder. And this denial continues despite an increasing array of neurobiological and social science research that clearly supports the concept of sexual addiction.

Much of this research is summarized in Harvard professor Martin Kafka’s 2010 position paper arguing in favor of Hypersexual Disorder (as he prefers to label the issue) as an official diagnosis in the American Psychiatric Association’s diagnostic bible, the DSM-5. Numerous other studies supporting sexual addiction—available here, here, here, here, here, here, here, and here, to cite but a few—have been published since Kafka’s summary. Moreover, anyone who’d like an up-close and personal look at sexual addiction can simply go to an open meeting (where everyone is welcome) of any 12 step sexual recovery group (SAA, SCA, SA, SLAA) to hear people talk about their addiction and the problems it has created.

Still, despite the obvious clinical realities and mounting scientific evidence, sex addiction deniers are as vociferous as ever. This small but noisy subset of clinicians fervently clings to their badly outdated 1970s ethos: “Do it because it feels good. And if it feels good, it can’t possibly be a problem. Ever. For anyone.”

Much like those who think that our increasing weather and eco-instability problems are random events unrelated to human activity, these misguided “sexologists” appear to have chosen willful ignorance over facts and reality. For instance, therapists have known for decades that early-life trauma and attachment concerns can and often do lead to adult addictions and adult intimacy disorders, but the sex addiction deniers say, “Not so.” More recently, therapists all over the country (and around the world) have anecdotally reported an evolving clientele of young adults self-identifying with porn-related compulsivity/addiction (related to the unfettered 24/7 availability of digital pornography), but the sex addiction deniers say, “Not so, they’re just kids trying to get comfortable with their sexual desires.” And so it goes.

Unfortunately, thanks in large part to these aging ideas and voices, America does not yet have a formal diagnosis for sexual addiction. (Notably, the World Health Organization’s diagnostic manual, the ICD-10, used pretty much everywhere but in the US, will likely include sex addiction with its next set of updates.) So individuals with substance abuse and gambling issues can be “officially” diagnosed and treated. The APA has even recognized internet gaming as a valid problem worthy of official investigation. But people who are compulsive with pornography and other sexual behaviors are inexplicably left in the dark. At times, this causes those who are already hurting and feeling crazy because they just can’t seem to stop masturbating to porn or hooking up via sex apps to feel even worse. And without an official label and directions for treatment, some sex addicts won’t pursue the excellent help that’s actually available. As such, they end up hopeless, discouraged, and depressed because they feel as if there are no answers.

Interestingly, even Psychology Today lags behind when it comes to sexual addiction, as their editors routinely reject, with one recent exception, any article that even mentions the problem as a treatable disorder. This frustrating stance recently pushed approximately a thousand psychotherapists to formally petition the magazine (click here or here to read the petition), asking the editors to reconsider their outdated position, noting that it serves neither the profession nor the individuals dealing with this disorder.

Given the undeniable clinical evidence and the increasing body of research backing it up, one wonders why some people are so intractably resistant to the idea of sexual addiction. Maybe we’re just caught in an argument about nomenclature. After all, for whatever reason the psychiatric community (as represented by the APA) seems to not like the word addiction. To this end, the APA has almost completely eliminated that term from the DSM-5, choosing instead to call alcoholism and drug addiction substance use disorders and gambling addiction gambling disorder. Oddly, the APA has altered the lexicon in this way even though the vast majority of people dealing with these issues are perfectly OK self-identifying as addicted and seeking help based on that label/diagnosis.

So now we are left with a confusing mish-mash of colloquial labels to describe the unfortunate individuals dealing with an ongoing, out-of-control pattern of sexual behaviors—sexual addiction, sexual compulsivity, hypersexuality, and hypersexual behavior, to name but a few. For what it’s worth, after treating this population for decades, I prefer the term sexual addiction. It’s not a pretty term, but it’s accurate. By any commonly used diagnostic criteria we are absolutely dealing with an addiction, so let’s call it an addiction. Moreover, the people who are suffering from this issue tend to identify with this label more than any other.

It is an unfortunate fact of human sexuality treatment that American professionals with differing opinions have chosen to build walls rather than windows. The sexology field and the sexual addiction field have so much they could learn from each other, yet ideological barriers have prevented our working together and developing common ground and a common language inclusive of all of our philosophies, experiences, and research. Well, I believe the time has come for us to stop throwing intellectual rocks at one another and to start working together. If we don’t do this, then how can we ever put resolution of our clients’ challenges first? It seems to me that only by moving beyond labels and preconceived notions as a field will we be able to steer our fellow humans onto the best healing pathway for their specific needs. That day can’t arrive soon enough for me and many of my clients.

]]>https://blogs.psychcentral.com/sex/2016/12/sex-and-porn-addictions-misconceptions-and-bias/feed/6What is Sex, Porn, and Sexting Rehab All About?https://blogs.psychcentral.com/sex/2016/11/what-is-sex-porn-and-sexting-rehab-all-about/
https://blogs.psychcentral.com/sex/2016/11/what-is-sex-porn-and-sexting-rehab-all-about/#commentsFri, 25 Nov 2016 21:49:52 +0000http://blogs.psychcentral.com/sex/?p=1809OK, sex addiction and sex addiction treatment are in the news again. This sort of thing typically happens at least a few times a year. The regular news cycle is […]]]>

OK, sex addiction and sex addiction treatment are in the news again. This sort of thing typically happens at least a few times a year. The regular news cycle is burbling along, and then some famous person lands in the middle of a big sex scandal (or several). At that point, everybody seems to want answers to these three very specific questions:

What is sexual addiction?

Is this person really a sex addict, or simply making excuses and/or trying to garner sympathy?

What happens in sex addiction rehab?

The first question is easy to answer: Sex addiction is an out-of-control pattern of compulsive sexual fantasies and behaviors that causes problems in the addict’s life.

Answering the second question is also relatively straightforward. Put simply, sex addiction is diagnosed based on the following criteria:

Preoccupation to the point of obsession with sex.

Loss of control over sexual behaviors, typically evidenced by multiple failed attempts to quit or cut back.

Directly related negative consequences (relationship issues, trouble at work or in school, depression, anxiety, loss of interest in previously enjoyable hobbies and activities, social and emotional isolation, legal trouble, etc.)

If the individual in question meets these three criteria, he or she is sexually addicted. Otherwise, that person is not a sex addict.

The answer to question #3 is a bit more involved, but still relatively straightforward.

Sex addiction rehab mirrors, in many ways, substance abuse treatment—generally implementing the same basic structure and cognitive-behavioral approach. The primary differences are the addictive behavior itself—compulsive sexuality rather than compulsive substance abuse—and the way in which sobriety (and therefore success) is defined.

With substance abuse issues, the ultimate goal is (nearly always) long-term abstinence. With sex addiction, however, sobriety is about learning to be sexual in non-compulsive, non-problematic, life-affirming ways. This is similar to the approach we take with eating disorders, another arena in which long-term abstinence is not feasible.

Nevertheless, sex addicts are typically asked to remain completely abstinent (including abstaining from masturbation) during their stay in rehab, which typically lasts anywhere from 30 to 90 days. This brief time-out from sex is mandated because most sex addicts, by the time they finally seek professional help, have completely lost touch with reality when it comes to their sex lives. They just have no idea which of their behaviors are problematic and which are not. Temporarily stepping away from all sexual activity gives them space in which to clear their heads and gain some clarity.

A common misperception about sex addiction rehab (and rehab for other forms of addiction) is that addicts, after completing an inpatient program, will be cured of their addiction. In reality, there is no cure for addiction (of any type). In this respect addiction is like diabetes—treatable, but not curable. So instead of focusing on curing a person who can’t actually be cured, rehab focuses on understanding the addiction and its consequences, establishing early sexual sobriety, and preparing the addict for the lifelong process of post-rehab recovery.

Addressing the addict’s denial—the minimizations, rationalizations, and outright lies the addict uses to justify his or her addictive behaviors. This means we go through the real facts of the situation to help the addict see the truth and the consequences of his or her addiction.

Identifying and eliciting responses to past trauma, abuse, grief, and other issues that typically drive all forms of intimacy and relationship dysfunction, including sexual addiction.

Identifying the addict’s triggers toward sexual acting out, and developing a healthy set of behaviors that the addict can turn to instead the addiction.

Helping to heal family strife, including the provision of support to betrayed spouses and other affected family members.

Starting the process of lifelong recovery from sexual addiction by creating supportive and responsive therapeutic communities the addict can rely upon not only during but after inpatient treatment.

For the most part, sex addiction rehab focuses on the present—the here and now—utilizing highly directive methodologies like Cognitive Behavior Therapy (CBT). With this approach, sex addicts are asked to look at the people, places, experiences, and feelings that trigger and reinforce their sexually addictive thoughts and behaviors. Then they develop and learn to implement methods of short-circuiting the addictive cycle. Essentially, they learn to recognize that they’ve been triggered, and to act in ways that counteract rather than reinforce their desire to act out sexually. That said, treatment proceeds with the past in mind, taking into account the fact that sex addicts tend to be trauma-driven rather than individuals who simply have no capacity for empathy or remorse. In other words, we understand that sex addicts are not bad people; instead, they are good people who’ve engaged in regrettable behaviors as part of their addiction.

It is important to state, once again, that sex addiction rehab does not cure sexual addiction. Instead, it interrupts long-established patterns of sexual acting out, and it provides a safe, structured setting in which sex addicts can build awareness of their addictive problem and coping skills they can turn to instead of their addiction. Usually, with or without the benefit of inpatient sex addiction treatment, addicts must battle their issue on an ongoing basis. Their desire to act out sexually does not ever completely go away. It lessens, certainly, and they learn to respond in non-addictive ways when triggered, but the desire to engage in their addiction does not fully disappear, no matter how good the treatment center or how motivated the addict.

]]>https://blogs.psychcentral.com/sex/2016/11/what-is-sex-porn-and-sexting-rehab-all-about/feed/3Addictions are Learned Behaviorshttps://blogs.psychcentral.com/sex/2016/11/addictions-are-learned-behaviors/
https://blogs.psychcentral.com/sex/2016/11/addictions-are-learned-behaviors/#commentsWed, 09 Nov 2016 19:31:50 +0000http://blogs.psychcentral.com/sex/?p=1804Anyone who’s ever been to a 12-step meeting has heard at least one or two recovering addicts say something like, “I got high because I had a crappy day at […]]]>

Anyone who’s ever been to a 12-step meeting has heard at least one or two recovering addicts say something like, “I got high because I had a crappy day at work and things got worse when I got home and I just got tired of feeling miserable.” That statement is very much in line with the commonly accepted idea of addictive behaviors as maladaptive coping responses used to deal with unwanted emotional discomfort. Essentially, addicts don’t want to feel stress, anxiety, sadness, and the like, so they “escape” and “numb out” by using a pleasurable and therefore emotionally distracting substance or behavior.

Generally, addicts develop this escapist response pattern early in life thanks to living in a dysfunctional home filled with inconsistent, neglectful, and perhaps even abusive caregivers. Essentially, as children they assume that these problems are their fault rather than the fault of their parents and/or others who should be caring for them. As a result, they develop a shame-based sense of self, where they believe they are defective and just plain not good enough to deserve the love and consistent care that they want/need. Over time, rather than turning to their unreliable and/or abusive caregivers, they learn to self-soothe their unmet emotional needs by ingesting a pleasurable substance or engaging in a pleasurable behavior. Eventually, that pleasurable (and therefore potentially addictive) substance or behavior becomes their go-to coping mechanism.

Later in life, as adults, they continue to use that or a similar coping mechanism. They think, “I could never trust anyone to be there for me when I was little and needed help or affection or someone to just listen to me, and I still can’t. As a kid, my mom was busy eating herself into an early grave, and my dad was busy drinking and cheating on my mom. Every time I reached out to one of them, they just shot me back down and I ended up feeling worse. So now, as an adult, when I have feelings that others might be able to help me with, I just can’t seem to reach out to them. I can’t bring myself to trust them, even if I intellectually know they’ll be there for me in a healthy way. So I reach out to a substance or a behavior instead, just as I did when I was little. That’s my coping mechanism for when I’m suffering.”

Of course, anyone who’s ever been around an addict for any length of time knows that addicts also use when they’re not suffering emotionally (or in any other way). In fact, addicts can be having a perfectly wonderful time and they’ll still turn to their addiction because that’s what they do no matter what. Yes, addicts use when they have a bad day, but they also use when they have a good day. They use because the sun came up. They use because the weather is nice. They use because election season is finally over. They use because they use. Period.

Of course, this idea puts a bit of a damper on the idea of addictions as maladaptive coping responses to unresolved childhood trauma and in-the-moment emotional discomfort—until one fully understands the ways in which traumatic early-life development and addictive substances and behaviors affect our neurobiological wiring.

Before getting into that, however, I think it might be wise to elucidate a bit on the role of early-life trauma in the formation of addictions. For starters, a considerable amount of research shows a direct link between childhood trauma, especially chronic (repeated and/or ongoing) trauma, and a wide variety of later life issues, including addictions. One significant and relatively well-known study tells us that people with chronic early-life trauma are:

8 times as likely to smoke cigarettes

9 times as likely to become obese

4 times as likely to experience ongoing anxiety

5 times as likely to experience panic reactions

6 times as likely to be depressed

6 times as likely to qualify as promiscuous

6 times as likely to engage in early-life sexual intercourse

2 times as likely to become alcoholic

1 times as likely to become intravenous drug users

Does this point to a strong connection between early-life trauma and addiction? You decide.

From my perspective, those of us who struggle with addiction and similar psychological issues typically learned early and well how to cope with abuse, neglect, and other forms of family dysfunction. We spaced out, we dissociated, and we found stimulation through substances, touching, and/or fantasy. That was our coping mechanism. It’s how we survived.

While other kids were bouncing on dad’s knee, we worried that he might hit us because he was drunk again. And thanks to this and other chronic abuse, neglect, fear, and caregiver unreliability, we came to believe that we were unworthy of proper love and care. That resulted, over time, in a distorted and highly negative sense of self, with every adverse experience simply reinforcing our deleterious self-image—defective, not good enough, unlovable. And with that as the general message bouncing around in our heads, it’s understandable that we might choose to escape through use of an addictive substance or behavior.

But what about the aforementioned addict who uses because the sun came up? Having a need/desire to self-soothe and emotionally self-regulate isn’t always this person’s motivation for picking up. In fact, this addict, like most true addicts, uses no matter what—even when life is just peachy, thank you very much. So what gives?

This is where neurochemistry and associative learning (also referred to as Hebbian Theory) come into play. Neurochemically speaking:

Addictive substances and behaviors uniformly evoke an intense pleasure response in the brain. This response is pretty much the same regardless of the substance or behavior that triggers it. (Dopamine, adrenaline, serotonin, and a few other pleasure-related neurochemicals are released into the brain and received by receptor neurons located in the nucleus accumbens—the brain’s rewards center.)

Thus activated, we start to feel pretty great, and anything that may have been bothering us a short while ago blissfully (though temporarily) fades away.

At the same time, the rewards center transmits information about how good we’re feeling to the memory and decision-making centers of our brain. In this respect, our neurons are a bit like adolescent girls texting information back and forth during an unusually tedious algebra lecture. They’re just downright gossipy.

Over time, this neurochemical exchange of information “teaches” our brains that using a particular addictive substance or behavior is a great way to not feel crummy. And this knowledge encourages us to repeat the usage as needed and/or desired.

Thus, it is relatively easy to understand why some people might consciously choose to use alcohol, drugs, or an addictive behavior (eating, gambling, video gaming, being sexual, etc.) as means of generating short-term relief from emotional turmoil, and why they might make this choice over and over. This does not, however, explain why an addict uses even when he or she is feeling fine. You know, “The birds are chirping so I think I’ll get high.” That sort of thing.

This is where associative learning comes into play. If you’re unfamiliar with the concept, watch a toddler who’s learning to walk, and then watch a child or an adult who’s mastered the process. The toddler must simultaneously and very consciously think about all sorts of things while he or she is figuring it out. “If I lift up this foot, I need to move it forward and put it back on the ground or I’ll fall. Whoops, I just fell. Let’s try that again.” But once the process is learned that same toddler can run around the house wreaking havoc with nary a conscious thought. This is associative learning at its best. We do something over and over and eventually we no longer have to think about it, because the methodology for doing it becomes hardwired into our brain.

Stated another way: Neurons that repeatedly fire together will eventually wire together.

This is as true with addiction as any other process. Basically, a traumatized person returns over and over to an addictive substance or behavior whenever he or she feels a twinge of emotional discomfort. Eventually, after this has occurred often enough, that person’s “using” neurons wire together, turning the choice to get high into an ingrained habit that is no easier to forget than learning how to walk. In this way, a conscious though maladaptive response to unresolved early-life trauma and later-life emotional discomfort becomes a habit (an automatic response) that, in certain circumstances, we might also refer to as an addiction.

This is why addicts don’t just use because they’re having a bad day. They use because that’s what the wiring in their brain tells them to do. They use no matter what.

]]>https://blogs.psychcentral.com/sex/2016/11/addictions-are-learned-behaviors/feed/1Men, Pornography, and the Desire to Quithttps://blogs.psychcentral.com/sex/2016/10/men-pornography-and-the-desire-to-quit/
https://blogs.psychcentral.com/sex/2016/10/men-pornography-and-the-desire-to-quit/#respondThu, 13 Oct 2016 18:09:23 +0000http://blogs.psychcentral.com/sex/?p=1798A few months ago I wrote about a recent French study looking at porn use among adult males and its consequences. In that study the research team concluded, among other findings, that men who look at porn to self-soothe and regulate their emotions were significantly more likely to experience porn related consequences and to view their usage as problematic. (Click here to read my earlier article.)

Now we have a relatively similar American study authored by Shane Kraus, Steve Martino, and Marc Potenza (from Bowling Green, Yale, and Yale). This research further examines the clinical characteristics of male porn users, in particular their interest in seeking treatment. The study surveyed 1,298 adult men who’d used porn at least once in the past 6 months. Participants were recruited via three websites—Craigslist.com, Psych-Research.com, and Psych.Hanover.edu. To ensure unbiased results the participants were not paid, though a $2 donation was made to the American Cancer Society for each completed questionnaire. The mean age of the men studied was 34.4, with test subjects hailing from the US (80%), Canada (8%), and various other English speaking countries (11%).

Participants in the study answered questions about:

Demographics—age, relationship status, education, etc.

Sexual History—number of sexual partners, frequency of masturbation, history of STDs, etc.

One in fifteen (6.4%) of the men studied reported previous treatment related to porn use. One in seven (14.3%) reported a current interest in seeking treatment.

More than one in four (28%) of the survey participants scored at or above the suggested Hypersexual Behavior Inventory cutoff, indicating the possibility of sexual addiction. This number almost exactly matches results in the French study, where 27.6% of the men studied either met or exceeded the HBI cutoff.

Note: The numbers in both studies are probably skewed in relation to the general population, as both survey samples were recruited exclusively online, and participation was limited to men who’d recently used pornography.

Of the individuals currently interested in treatment related to porn use, 71% scored at or above the HBI’s sex addiction cutoff, with 29% not meeting that standard. About this latter group, the authors of the study state:

Specifically, it would be important to understand whether additional factors (e.g., relationship status, level of religiosity, and personal values/beliefs) relate to men’s self-reported interest in seeking treatment for use of pornography.

This strikes me as a reasonable interpretation of the findings, very much in accord with anecdotal evidence provided by certified sex addiction treatment specialists (CSATs) who, in a general way, report that a small percentage of clients seeking assistance related to porn use have based their self-assessment of sex/porn addiction on shame and self-loathing rather than on commonly accepted clinical criteria. Moreover, this seems to occur far more often in clients with conservative religious backgrounds—environments where porn and other forms of non-marital sex are often vilified.

Further analysis shows that when compared with treatment disinterested men, the treatment interested population uses porn more often and for longer periods of time, has many more cut back and quit attempts, and scores significantly higher overall on the Hypersexual Behavior Inventory. These findings are unsurprising, and they line up perfectly with the criteria typically used by CSATs to identify and diagnose sex and porn addiction:

Preoccupation to the point of obsession (best evidenced by frequency and duration of use)

Loss of control (typically evidenced by multiple failed attempts to quit or cut back)

Findings regarding failed attempts to cut back or quit altogether are especially enlightening in this study. With treatment disinterested men 34.6% had tried to cut back at least once, and 25.0% had tried to quit at least once. With treatment interested men the numbers were much higher, with 87.1% trying to cut back at least once, and 74.7% trying to quit at least once. Moreover, treatment interested men were 4.1 times as likely to have tried cutting back on four or more occasions, and 6.9 times as likely to have tried quitting on four or more occasions—numbers that indicate the same “loss of control” we see with other types of addiction.

Unfortunately, the new study did not look deeply at motivations for use. If it had, it would likely have confirmed the French study’s finding that attempts to self-soothe and regulate emotions are directly linked to negative consequences—an important result as it provides another significant parallel between sexual addiction and other forms of addiction. (In general, addictions of all types are motivated more by a desire for escape than a desire for pleasure.)

Still, Kraus, Martino, and Potenza have provided yet another link in the chain that will eventually force the hand of the American Psychiatric Association, an organization that has so far chosen to willfully ignore the existence of sexual addiction—this despite an APA commissioned position paper written by Harvard’s Dr. Martin Kafka recommending the inclusion of Hypersexual Disorder, as Kafka prefers to call this issue, in the DSM-5.

For now, CSATs and others who treat sexually addicted clients will continue to diagnose and treat sexually addicted individuals as we have always done, using the generally accepted though unofficial diagnostic criteria outlined above to identify the disorder (erring on the side of caution by under rather than over diagnosing), and then treating the disorder in ways that have proven effective with not only sexual addiction, but other addictions. Most often this involves a combination of inpatient and/or outpatient individual and group therapy that relies heavily on cognitive behavioral and accountability tasks, coupled with social learning and external support (including participation in 12-step groups like SA, SAA, SCA, and SLAA).